Healthcare Provider Details

I. General information

NPI: 1659348597
Provider Name (Legal Business Name): CARL M HIGUCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/17/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98211 MOANALUA ROAD SUITE 320
AIEA HI
96701
US

IV. Provider business mailing address

98211 MOANALUA ROAD SUITE 320
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-7447
  • Fax: 808-487-7557
Mailing address:
  • Phone: 808-487-7447
  • Fax: 808-487-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD7219
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: